| NPI | 1225021140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 20050035766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0428745) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2025-03-20 |